4.3.2 Guidelines: From theory to practice for enhanced patient care

PN is indicated for use in adults, children, and infants across a variety of medical conditions and is therefore considered an integral part of nutrition care. However, given that PN is classified as a high-alert medication (i.e., carries a heightened risk of causing harm if used in error), development of evidence-based guidance on how to safely manage this complex therapy in both the hospital and community setting (including the transition from EN to PN) is essential to maximise clinical benefit while minimising risk for error and harm.

The decision to initiate PN and its implementation requires input from multiple disciplines and agencies and may also involve ethical considerations for certain patients, such as those nearing the end of life and patients who do not have the capacity to take part in the decision-making process. Consequently, internationally recognised organisations such as the European Society for Clinical Nutrition and Metabolism (ESPEN), the European Society for Paediatric Gastroenterology Hepatology and Nutrition, the American Society for Parenteral and Enteral Nutrition (ASPEN), and the UK National Institute for Health and Care Excellence have produced practical guidance for healthcare providers to aid the delivery of PN. Details of key publications focusing on the practical and ethical aspects of PN are shown in Table 4.48.